Provider Demographics
NPI:1962162933
Name:WESTLEY, OLIVIA GARCIA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GARCIA
Last Name:WESTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14515 MOJAVE DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-6762
Mailing Address - Country:US
Mailing Address - Phone:760-955-7898
Mailing Address - Fax:760-843-4104
Practice Address - Street 1:14515 MOJAVE DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-6762
Practice Address - Country:US
Practice Address - Phone:760-955-7898
Practice Address - Fax:760-843-4104
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66860183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician